Toxic Toll

Is work worth dying for?

It sounds like hyperbole, but that’s the reality that author Jeffrey Pfeffer says company leaders should face, as adverse work conditions are taking a serious toll on employees’ physical and mental health–and, in turn, on businesses’ bottom lines.

According to research by Pfeffer and his colleagues in Dying for a Paycheck, about $190 billion in annual healthcare costs in the country can be linked to stress-inducing work conditions–factors such as low job control, lack of health insurance, long work hours and high job demands. Stress-related sickness isn’t just bad for the employee but also for the company, as it can contribute to a lack of productivity, high turnover and low morale.

Pfeffer, the Thomas D. Dee II Professor of Organizational Behavior at Stanford University’s Graduate School of Business, argues in his new book that the same level of attention and action that has been given to environmental sustainability needs to be invested in human sustainability–and that starts in the workplace.

HRE sat down with Pfeffer to find out how HR leaders can be influential in helping their companies revamp not only policies and procedures, but also their culture, to produce healthier workplaces.

You mention in Dying for a Paycheck that employees can often recognize for themselves when they’re practicing unhealthy behaviors, and that they need to shift that recognition to action. Do you think HR can be influential in that process and, if so, how?

HR can certainly be helpful in encouraging employers to build healthier workplaces and encouraging healthier behaviors on the part of managers, who may be causing so many difficulties. I’m not so sure [HR] can actually help people to recognize these behaviors. HR’s primary responsibility is to the employer and to getting them to recognize the dimensions of what they are doing to make people sick.

The book notes that American culture generally teaches workers that there is value in being constantly “on” and busy. How then can an organization successfully challenge something that’s so ingrained in our society?

First of all, you build norms that say it’s not alright for managers or leaders to email employees on the weekends, off hours. Tell employees that when they go home, they’re done. Places like SAS Institute and Patagonia have done this. Plenty of companies–though not tons–have said that the expectation is you will work hard at work and then go home, and work won’t interfere with the rest of your life. There are companies that have sanctioned managers, and measured managers and leaders, by the extent to which employees are healthy and engaged and feeling good about working for the organization. There’s enough variation in organizational practices and cultures, even within U.S. cities, that I think it’s certainly possible to see that you do not have to, as a company, succumb to this kind of value that you need to work all the time. There’s a wonderful chart in The Economist  that shows the irony that studies have revealed a negative relationship between hours worked and performance and productivity.

Do you think that point–about performance and productivity–can help HR leaders make the case to the C-suite about the need to promote lower-stress environments?

Yes. There’s the point that when people are sick, they don’t do very good work. There’s also the point that survey data, some of which I cite in the book, talk about the relationship between turnover and unhealthy workplaces. There’s a lot of data that can help HR professionals make the case that employers have created a lose-lose situation where employees are losing their health and employers are losing as well because these long hours don’t benefit either of them.

There have been a number of studies recently that have found traditional wellness programs are ineffectual. How do you think workplaces can develop wellness initiatives that contribute meaningfully to improve their employees’ health?

Wellness initiatives are often focused on the wrong place–on individual employees [instead of company culture]. If there’s a boss or a workplace that doesn’t offer job control, that doesn’t put you in a situation of economic security–such as with the constant threat of layoffs–the response may be eating comfort food, smoking more, drinking or using illegal narcotic substances because these are all ways in which people cope with stressful environments.

Following the insight of the quality movement, prevention is usually more effective and less expensive than remediation. If I’m driving you nuts in the workplace in a variety of ways and just give you a gym membership to try to help you overcome this, [I should] instead try to prevent the bad behavior or bad work conditions in the first place.

That goes to things like more control over the job, [the lack of] which has been found to predict cardiovascular diseases. Giving people more security, affordable healthcare, reasonable work hours and encouraging them to take their vacations and come back refreshed … . If you’re doing all of these things, then it’s possible that traditional wellness programs might actually have some effect. But the idea of putting wellness programs in place that overcome all of the other negative things going on is a goal that’s unlikely.

All indications are that the gig economy is going to keep picking up steam in the near future. Do you think that will cause health outcomes to continue to deteriorate?

There are proposals that, of course, have not yet been adopted but say that, in this economy in which people are moving around more and working these gigs, the idea that all benefits–not only health insurance but unemployment, workers’ compensation and even retirement plans–are tied to an employer makes no sense. There are proposals to have employers handle all of this in a different way. Right now, a lot of employers have this cliff: Full-time employees get X, and part-time or gig workers get nothing. That makes no sense. It ought to be proportional. So, for instance, if I hire you, I would pay–based upon your wages and hours worked–into some collective fund on your behalf, with a certain percentage that would go into an unemployment account, a certain percentage into a workers’ compensation account, a certain percentage for health insurance and then retirement. But absent that, we’re going to have lots of trouble.

We already have a system in which most people who are at retirement age have nothing to retire on, and this [gig economy] will only make it worse. People haven’t been able to save even with employer-sponsored retirement benefits, so how are they going to save without them?

In the book, you draw comparisons between the attention given to environmental pollutants in recent years and the need for similar attention to the work atmosphere. What lessons, good or bad, do you think the latter movement could learn from the former?

We decided to take environmental pollutants seriously for a simple reason: We figured out that employers would make better decisions if they could see the full costs of those decisions.

For instance, it is very cheap for me to throw trash on my neighbor’s lawn. If I’m doing that for a year, however, it will cost him a lot of money to clean it up and I’d overproduce trash and would have externalized my costs. Therefore, we require that people have mandatory garbage collection. Similarly with water, once you start dumping things in the river, it’s difficult to get them out and it externalizes the cost. Rather than passing those costs onto the larger society, companies need to be accountable so they’ll make smarter decisions.

Today, companies are making employees too sick to work, and it’s the thinking of, “They’ll become someone else’s problem, not mine.” The company is externalizing costs onto the larger healthcare system, onto the welfare system, onto the public-assistance system. We’re permitting companies to do what we used to allow to happen to the physical environment. And in the exact same way, we have to confront costs and make smarter decisions, and focus more on prevention rather than the need for remediation.

In this age of the #MeToo movement, a lot of workplaces are having discussions about sexual harassment. What role do you think sexual harassment has played in impacting unhealthy work environments–and do you think this current movement has the potential to effect sustainable change?

This is probably not politically popular but it’s true: Sexual harassment, to me, is, among other things, another manifestation of workplace bullying. Data suggest bullying–whether it’s because of race, gender, disability–has adverse health effects. We know people who are bullied in the workplace feel unsafe and suffer stress because of that. To the extent that we can, we have to make workplaces less discriminatory, less harassing, less bullying, less dangerous–physically and psychologically–and people will have less stress and better health outcomes. Any move to curtail sexual harassment will be helpful for people’s health. There’s no question about that.

What role do you think mental-health stigma plays in unhealthy work environments, particularly when it comes to workers voicing concern about their own stress level?

I suspect there is some issue, and I think part of it is stigma about mental health, and part is also this idea of, “I don’t want to let on that I can’t cope with the workplace.” In a country that has at-will employment, going to a boss and saying, “I can’t deal with the stress of work or the hours” may make people very concerned about their job.

Therefore, I think people try to power through. You can see that in the stories I tell in the book; even in really high-skilled, high-wage jobs, where people are trying to build their careers, they’re worrying about keeping their jobs and don’t want to share this information with their employer. I think it reflects a lack of trust in companies and in a boss that they will look out for [employees’] well-being and best interests. If there was more trust, people would be more willing to come forward but, absent that, they try to power through and hide it.

You mentioned that workers bring “baggage” from previous unhealthy work environments. How do you suggest they best navigate letting go of, or at least managing, that baggage? And do you think the company, particularly HR, plays any role in that process?

I think the best employers basically set out policies to guide a healthy workplace–policies that say that work is not supposed to be 100 percent of your life and that the employer is going to provide things that create a sense of community for employees and, therefore, social support. The evidence is pretty clear that if you have social support–friends at work or a supportive boss–you can reduce your stress level. The employer has to say, “I’m going to be there for you,” and that doesn’t take a lot. There’s an example or two of a company doing something unexpected on behalf of an employee; the story goes throughout the place of employment and then people say, “Wow, this is an employer that does care about me as a human being, not as a factor of production.” Trust in the employer will be boosted and people will become much more engaged, less likely to leave and more likely to do better work. And they’ll also be in a different place psychologically.

You mentioned a lot of companies that are getting it right: Patagonia, Zillow, DaVita. Each has taken a very different approach to building healthy workplaces. What is a common thread among them all?

I think it’s how they look at their workforce. I wrote a column for Fortune titled “Why Have Employees?” and interviewed various people about that issue. We live in a world where some organizations see employees as a necessary evil. They’d like to get rid of them and automate their work, or make them part-time or gig workers. Other companies see employees as the true source of competitive advantage. The relationship between employer and employee in the long term is not about transaction; they see the organization as more of a community and themselves as having a responsibility to their workforce. It all comes down to how people see their responsibilities as leaders of these companies. It’s the philosophy: “I believe that I have a responsibility to ensure that, at the end of the day, you leave in as good shape as you arrive,” or instead, “It is my job to extract as much as possible as I can from you–to use you up and spit you out.” Everything comes down to the philosophy of the leaders.

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Jen Colletta
Jen Colletta is managing editor at HRE. She earned bachelor's and master's degrees in writing from La Salle University in Philadelphia and spent 10 years as a newspaper reporter and editor before joining HRE. She can be reached at [email protected]